Macomb County Community Mental Health
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Home and Community Based Services

Home and Community Based Services Update #6 (posted 5/17/18)

Across Macomb County our Residential and Non-Residential Providers are thoughtfully working on Corrective Action Plans (CAPs) to best remediate areas of concern discovered in the annual federal mandated Home and Community Based Services (HCBS) surveys. These surveys are the primary tool that the Michigan Department of Health and Human Services MDHHS used to construct our Michigan State Transition Plan. (STP)  When these plans are submitted to the Center for Medicare/Medicaid Services, they will decide whether our state is in substantial alliance and compliance with the HCBS Final Rule.

The HCBS Final Rule is a Federal regulatory design that aims to improve the care and daily living experience of our Intellectually Developmentally Delayed (IDD) and some of our Severe Mentally Ill (SMI) consumers. The HCBS Final Rule specifically targets those IDD/SMI consumers that live in a dependent setting like a Licensed Specialized Adult Foster Home (AFC) and receive specialized clinical services like Community Living Services (CLS), Skill Building, and Vocational Services.

The HCBS Final Rule mandates consumers living in a dependent setting receive their Medicaid services integrated into our general community, in a non-isolating manner, and not isolated from the greater community. It requires providers to respect individual choice, and support consumer self-determination.

The HCBS Final Rule and State Transition Plans across the county bring an element of “high level” or big picture trends across these treatment services. It may have the effect of assessing the delivery of care, moving from a reporting style measurement, to more direct focused elements on outcome based measurement. This is a trend across health care in general.

Our MCCMH system values all our provider partners. Together we are greater than the sum of our parts. Our joint fields recognize that examining our efficiency and efficacy by prudent measurement are part of our fabric of service today. 

Home and Community Based Services Update #5 (posted 3/19/18)

Macomb County Community Mental Health is now in the process of completing the B3 Wavier Survey. For our people served, their family and friends, plus our Provider Network, the time taken to address this meaningful task is appreciated.

In February, letters from Michigan Health and Human Services (MDHHS) outlining areas of opportunity and requests for changes were distributed to Residential and Non-Residential Providers involved in the HCBS Part I and II Surveys done in the fall of 2017. There are Corrective Action Plans (CAPs) for both types of Providers to come into compliance with the HCBS Final Rule by March of 2019. Running concurrently is the MDHHS effort at Heightened Scrutiny (HS) Resolution directed by MDHHS. There is a MDHHS Frequently Asked Question link at the end of this update for reference. s an aide to general understanding, and l background,  Please see  State of Michigan Medicaid Provider Manual Policy Bulletin MSA-17-31 is below: (Link available below)

In order to comply with the federal HCBS Final Rule, (…) providers must:

• Ensure individual rights of privacy, dignity and respect, and freedom from coercion and

restraint

• Enhance independence

• Enhance independence in making life choices

• Enable choice regarding services and who provides them

• Ensure that the setting is integrated in and supports full access to the greater

community

 

The HCBS Final Rule is focused upon consumer choice. We promote our consumers to engage in meaningful choice and active participation in MCCMH services. We want to help build consumer self-direction and meaningful participation in all aspects of our shared community.  We work with an ardent desire to have our Michigan Constitutionally mandated CMH IDD service population, experience community inclusion to receive services in a non-isolative manner within our community while living in a non-institutional setting.  

 

http://www.michigan.gov/documents/mdhhs/MDHHS_FAQ._R_6.26.17docx_576922_7.pdf

http://www.michigan.gov/documents/mdhhs/MSA_17-31_599587_7_600816_7.pdf


FAQ - Heightened Scrutiny, shared by Michigan Department of Health and Human Services (posted 1/17/18)

Home and Community Based Update #4

Dec. 20, 2017 -- Part of the State Transition Plan (STP) for the Home and Community Based Service (HCBS) Final Rule is examining and correcting settings that may not meet these new rules and guidelines yet. The HCBS survey process helped the Michigan Department of Health and Human Services to identify Providers or settings, in all 10 Regions across the state that are not currently compliant with HCBS Final Rule guidelines. The State Transition Plan includes allowing time and support to Providers that choose to continue providing services, to come into compliance.

MCCMH values our Provider Network. We plan to partner with Non-Compliant Providers to make changes and reach HCBS Final Rule compliance. All 10 Regional PIHPs are using a Corrective Action Plan (CAP) process as a tool to achieve this goal.

The Macomb Notification letters will be out to Providers by February 12. They will be delivered with the CAPs material, and the entire packet will come through the secure MCCMH Business Management Portal. This method is password secure. It is the same process used to deliver annual contracts and important business documents.

Most of the Non-compliant issues will involve the seven mandated requirements of the HCBS Final Rule. (See below) Those Providers that provide service in other Regions and counties may already be familiar with the CAP process. It is anticipated that corrective strategies that were found acceptable in other PIHP/CMHSP settings will also be viable, albeit with small “tweaks” in others. Please remember the CAP process is multi-layered, i.e. MDHHS reviews and gives final approval to all CAPs state wide, which will in turn are then reviewed and given final approval by CMS.

• Individual has a lease or other legally enforceable agreement providing similar protection;

• Setting is selected by the individual from among setting options;

• Individual has privacy in his/her unit including lockable doors;

• Individual has a choice of roommates (if applicable) and freedom to furnish or decorate the unit;

• Individual controls his/her own schedule, including access to food at any time;

• Individual can have visitors at any time; and

• Setting is physically accessible.

 

Providers can please see the Michigan Department of Health and Human Services (MDHHS) HCBS web page http://www.michigan.gov/mdhhs/0,5885,7-339-71547_2943-334724--,00.html  or outreach the HSW Administrator for Macomb at email ken.schleicher@mccmh.net

Home and Community Based Services Update Grapevine #3

Dec. 11, 2017 --  In October the notification letters for residential and non-residential providers found to be in HCBS Heightened Scrutiny were sent out. It is important to remember HCBS Heightened Scrutiny is reversible. The “scrutiny” refers to the Provider’s service delivery, and not the consumer’s medically needed treatment. The entire HCBS Final Rule is overseen by the Federal Center for Medicare and Medicaid Service (CMS) in our nation’s capital.

Providers were tagged for this status based upon consumer and/or provider answers to HCBS survey questions, as developed by Michigan Department of Health and Human Services (DMHHS) and facilitated by Development Disability Institute of Wayne State University (DDI/WSU).

What does this mean? The Heightened Scrutiny category means that initial MDHHS State Transition Plan surveys identified the provider as possibly having qualities that may be institutional like, or having the effect of isolating the consumer, or of lacking consumer integration into the greater community. Improving the daily life quality for consumers in these three areas is the milestone aim of the HCBS Final Rule.

The first step locally for both Providers and individuals receiving services in a setting found to be in Heightened Scrutiny is official notification by letter. After that an official decision of intent or choice by both consumer and provider is required.

The Heightened Scrutiny category can only be remediated by the Michigan Department of Health and Human Services.  Consumer choice is preserved by the treatment system. This process is not abrupt. The resolution will unfold along lines designed to facilitate zero interruption in consumer care.

Resources are available to help the providers. MCCMH is dedicated to improving our treatment network and the services that we provide to our consumers and families.

See the following links for more detailed information. You can also contact the MCCMH HSW Administrator, HCBS-B3@mccmh.net or work cell: 586 602 3010.

Home and Community Based Services Update Grapevine #2

Our MCCMH Pre-Paid Inpatient Healthcare Plan (PIHP) is approaching the end of another HSW Waiver survey period. This portion of the survey process focused on consumers receiving what used to be commonly called the Michigan HSW B3 Waiver plan. Both the former HCBS C Waiver and the HSW B3 Waiver now are referred to as 1115 Waivers.

We have been surveying consumers, facilitated by Case managers, and Providers of Community Living services, Skill Building services, Supported Employment services, and Licensed Adult Foster Care Home Providers as directed by the Michigan Department of Health and Human Services. Our purpose is to fulfill the State Transition Plan on Compliance with the federally mandated Home and Community Based Service (HCBS) Final Rule first rolled out in 2014.

We have already commented on the overarching philosophy of promoting inclusion, community integration and avoidance of institutional-like care for our consumer populations. A short summation statement of the HCBS Final Rule is reviewed here as General Philosophical Requirements:

·         Ensure individual rights of privacy, dignity and respect, and freedom from coercion and restraint

·         Enhance independence

·         Enhance independence in making life choices

·         Enable choice regarding services and who provides them

·         Ensure that the setting is integrated in and supports full access to the greater community.

There are also seven concrete objectives which are designed to assure and promote respect, dignity, and personal choice. Here is a specific list of the HSW Final Rule Components for Compliance:

·         Setting is selected by the individual from among setting options;

·         Individual has a lease or other legally enforceable agreement providing similar protection

·         Individual has privacy in his/her unit including lockable doors

·         Individual has a choice of roommates (if applicable) and freedom to furnish or decorate the unit

·         Individual controls his/her own schedule, including access to food at any time

·         Individual can have visitors at any time

·         Setting is physically accessible.

 

Over the coming year the supporting policies and procedures will be woven into our ongoing Strategic Plan to assure the PIHP network successfully meets these Federal Mandated standards.

Home and Community Based Services Update Grapevine #1

Oct. 11, 2017 -- Our county, as represented by MCCMH, Prepaid Inpatient Health Plan, expects to receive notification this month of initial results and findings from last year’s HCBS Participant and Provider survey initiated by Michigan Department of Health and Human Services. This effort is commonly called the HCBS Survey, Part I and II. The survey sent questionnaires to measure both consumer and service providers’ compliance with the federally mandated HCBS Final Rule. Our first survey was completed last December. When this effort started in 2014, we were given a five year time period to come into compliance, 2019. This year the Federal government has given all states another three years.

Three types of outcomes are expected from the HCBS Final Rule survey process; compliance, non-compliance and Heightened Scrutiny status. If a provider agency is judged as compliant, no immediate action is necessary.

For providers found out of compliance, there will be a period of correction opportunity encouraged. This should allow most providers to come into HCBS Final Rule compliance. It is also possible that a small percentage of provider agencies may fall into the third, Heightened Scrutiny (HS) status.

This last category means that joint work between the provider agency and Michigan Department of Health and Human Services will need to occur in order for the provider to remain in good standing with the Department. This step must be accomplished in order for Macomb, our PIHP, to continue to contract for services using Medicaid funds.

The federally mandated compliance with HCBS Final Rule promotes equal access and participation opportunity to the larger community. There are broad philosophic goals of equality, dignity of person, and respect.

These high level requirements and rules are identified. Each community across the nation is challenged to demonstrate adherence to the HCBS Final Rule when providing specialized Behavioral Healthcare services to our mission target groups; seriously mentally ill, (SMI) intellectually developmentally delayed, (IDD) and seriously emotionally disturbed children and adolescents. (SED)

All providers must demonstrate compliance in their business settings in these three areas.  The provider agency must be non-Institutional like in environment and practice. The provider agency should not isolate consumers by practice or effect. HCCBS recipients should enjoy the same community access as the average citizen. Lastly the provider agency and business setting should promote inclusion and equal access to meaningfully participate in the larger community.